Healthcare Provider Details

I. General information

NPI: 1972183119
Provider Name (Legal Business Name): WYSONG ENTERPRISES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 N CENTRAL EXPY STE 210
DALLAS TX
75204-3868
US

IV. Provider business mailing address

7424 AZALEA LN
DALLAS TX
75230-3640
US

V. Phone/Fax

Practice location:
  • Phone: 214-906-5138
  • Fax:
Mailing address:
  • Phone: 214-906-5138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. ERIN L WYSONG-WAREN
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LPC-S
Phone: 214-906-5138